The following is the summary of “Antimicrobial Photodynamic Therapy in the Nasal Decolonization of Maintenance Hemodialysis Patients: A Pilot Randomized Trial,” published in the May 2023 issue of Kidney Disease by Bezerra, et al.

Infections are a leading cause of death in the hemodialysis population. Previous nasal colonization is a risk factor for infection, and Staphylococcus aureus is a joint etiological agent. Repeated antimicrobial decontamination in this population lowers infection levels. However, this practice can lead to antibiotic resistance. Experts compared mupirocin treatment, often used to kill S. aureus in the nose, to photodynamic therapy, a potential bactericidal treatment that does not generate resistance. For decolonization, people were given either a single application of photodynamic treatment (660 nm, 400 mW/cm², 300 seconds, methylene blue 0.01%) or a topical mupirocin regimen (twice a day for five days).

Nasal swabs were taken at time 0 (when the carrier state was discovered) immediately after treatment, one month later, and three months later. Antimicrobial susceptibility was assessed, and bacterial isolates were put through proteome analysis to determine the species present.

Treatment adherence was 100% among the 17 patients assigned to photodynamic therapy and 77% among the 17 patients assigned to mupirocin. 12 patients treated with photodynamic therapy (71%) and 13 patients treated with mupirocin (77%) had S. aureus-negative cultures immediately following treatment (risk ratio, 0.92 [95% CI, 0.61-1.38], (P=0.9). 

Within 3 months of finishing photodynamic therapy, 67% of patients who initially had negative cultures were recolonized. In the group that received photodynamic treatment, no adverse outcomes occurred. Only nasal colonization was tested for. Hence, no consideration was given to the possibility of infectious consequences.

Source: sciencedirect.com/science/article/abs/pii/S0272638622010137